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Infantile Liquid Therapy ObjectiveSummaryCharacteristicofInfantileBodyFluidBalanceFluid,Electrolyte,&Acid-baseDisordersCommonSolution of LiquidTherapyInfantileDiarrheaLiquidTherapyInfantile Liquid Therapy Objec1ObjectiveCharacteristicofInfantileBodyFluidBalance RealizedPathophysiologyofInfantileFluid,Electrolyte&Acid-baseImbalanceBe familiar withClinicalmenifestationsofInfantileFluid,Electrolyte&Acid-baseDisordersMasteredCommonSolutionComponentofLiquidTherapy Be familiar withLiquidTherapyofInfantileDiarrheaMasteredObjectiveCharacteristic of Inf2Summary Bodyfluidisimportantcomponentofhumanbodyandthephysiologicalequilibriumofbodyfluidisanimportantfactorforhumanliving.Thedynamicequilibriumoffluid,electrolyte,acid-base,osmoticpressuredependsonnormalregulatingfunctionofnerve,incretion,lungandkidney.Becauseoftheinfantilephysiologicpeculiarity,Thesesystematicfunctionsareeasilyaffectedbydiseasesand/orenvironmentandaremaladjusted.Therefore,thedisorderofwater,electrolyteandacid-baseiscommoninpediatricclinic.Summary Body fluid is im3Characteristic ofInfantileBodyFluidBalanceA.Total body water&its distributionBody water compartments related to age(total body mass%)AgeAge TBWTBWECFECF ICFICFPlasmaISFISFNewborninfant78637351year7052540214years6652040Adult5566510154045TBW:totalbodywaterECF:extracellularfluidICF:intracellularfluidISF:interestitialfluidCharacteristic of Infantile Bo4Characteristic of Infantile Body Fluid BalanceB.Electrolyte composition of body fluidECF:Na+、Cl-，HCO3-ICF:K+、Mg 2+、HPO4 2-、ProteinC.Water metabolism a.Largewaterrequirements,swiftwaterexchange,unobvious waterloss(doubleadultsamount).Infantswaterexchangeamountis1/2ofECF,theadultsisjust1/7.b.Immaturebodyliquidregulatingfunction,immatureconcentrationanddilutionfunctionofinfantile.Characteristic of Infantile Bo5Fluid,Electrolyte&Acid-baseDisordersA.Degree of dehydration DehydrationMildModerateSevereDecreaseinbodyweight5(50ml/kg)510(50100ml/kg)10(100120ml/kg)PsycheDepressed,hyperirritableDepressed,hyperirritableLethargic,comaOrbit,FontanelSunkenSunkenSeverelysunkenSkinturgorNormalDecreaseMarkedlydecreaseMucousmembranesDryDrySeverelydryTearsDecreaseDecreaseAbsentUrineMildoliguriaoliguriaAnuriaBloodpressureNormalNormalLowFluid,Electrolyte&Acid-base6TypeofdehydrationPathogenySerumsodiumPathophysiology&clinicalcharacteristicIsosmoticAcutegastrointestinalfluidlose130150mmol/LECF:decrease,Osmoticpressure(intracellular=extracellular)DehydrantvolumeaccordwithdehydrantphysicalsignHypotonicChronicgastrointestinalfluidlose150mmol/LICF:severelydecrease,MilderdehydrantsignthantheothertwokindsFluid,Electrolyte&Acid-baseDisordersB.Property of dehydrationType of dehydrationPathogenySe7C.Metabolic acidosisPathogeny 1.The lose of large amount of basic substances（gastrointestinal tract,kidneys）2.Too much Acid metabolite（hungriness,diabetes,renal failure,hypoxia）3.Too much acid substance intake（long time to take calcium chloride,ammonium chloride,amino acid etc.）DegreeMild HCO3-1813 mmol/LModerate HCO3-139 mmol/LSevere HCO3-9 mmol/LFluid,Electrolyte&Acid-baseDisordersC.Metabolic acidosisFluid,8D.Hypokalemia Pathogeny 1.Lackofintake2.Lossofkaliumfromkidneysorgastrointestinaltract3.Burn,dialysisetc.4.Abnormalkaliumdistributioninsideoroutsidecells（alkalosis,insulintherapy、periodicanesthesia）Fluid,Electrolyte&Acid-baseDisordersD.Hypokalemia Fluid,Electrol9Clinical menifetation1.Nervoussystemdepressed2.Muscleinertiaoflimbs，musculartensiondown，severelyretardantparalysis，respiratorymuscleparalysis3.Heartheartrateincreasing,arrhythmia,AdamsStokessyndrome,heartratedecreasing，atrioventricularblock,heartsoundlowering,cardiogram:Uwaveappearing，UT，flattenedTwave4.Kidneyconcentratingfunctionlowering,urinevolumeincreasingFluid,Electrolyte&Acid-baseDisordersClinical menifetationFluid,E10CommonSolutionofLiquidTherapyA.Nonelectrolyte solution5、10 glucoseB.Electrolyte solution 0.9 NaCl、1.4、5 NaHCO3、10 KClC.Mixed solutions refer to the following tableCommon Solution of Liquid Ther11Common mixed solution0.9%NaCl1.4%NaHCO3510%G.S2:1213:2:12134:3:24236:2:1216CommonSolutionofLiquidTherapyCommon mixed solution0.9%NaCl12InfantileDiarrheaLiquidTherapyA.VolumeDegreeTotalvolumeCumulatedlosingvolumeKeeptransfusingperiod（physiologicalneed,losingcontinuing）Mild90120ml/kg4560ml/kg4560ml/kgModerate120150ml/kg6075ml/kg6075ml/kgSevere150180ml/kg7590ml/kg7590ml/kgInfantile Diarrhea Liquid The13B.QualityDehydrantcategoryCumulatedlosingvolumeKeeptransfusingperiod（physiologicalneed,losingcontinuing）Hypotonicdehydration4:3:21/31/4 Sodic solutionIsosmoticdehydration3:2:11/31/4Sodic solutionHyperosmoticdehydration1/3 Sodic solution1/31/4Sodic solutionInfantileDiarrheaLiquidTherapyB.QualityDehydrant category14C.SpeedTotalvolumeCumulatedlosingvolumeKeeptransfusingperiod（physiologicalneed,losingcontinuing）24h812h1216h810ml/kg/h5ml/kg/hInfantileDiarrheaLiquidTherapyC.SpeedTotal volumeCumulat15D.Shock volume expansionVolume Solution Speed20ml/kg2:1 or 1.4NaHCO33060minInfantileDiarrheaLiquidTherapyTotalvolume 300mlVolume Solution Speed20ml/kg2:16E.Treatment of metabolic acidosis Mildormoderatemetabolicacidosismetabolicacidosis:NospecialtreatmentSeveremetabolicacidosis：1.4%NaHCO3 3ml/kg，HCO3-level can increase about 1 mmol.F.Treatment of hypokalemiaSupplykaliumafterurination(urination6hoursofpreadmission,bladderpercussingdullnote)Kaliumsupplementconcentration:0.20.3(0.3)VenoclysisperiodoftotalKaliumsupplementperday8hours.InfantileDiarrheaLiquidTherapyE.Treatment of metabolic a17Case analysisInfant,male,9months,diarrhea2days,admissiondate1998-08-10.Aftereatingun-boiledbeancurd2daysago,yellowwaterishstools,bulky,noblood,notenesmus,defecation1015/day;onestool6hoursofpreadmission,alittle,yellowurine.Physicalexamination：T38C,R32/min,P120/min,dyspyoria,Fontanel1.51.5cm2,sunken,orbitsunken,decreasedSkinturgor,drylip,dryperiglottis,pharynx(),heartrate120/min,noarrhythmia,milddullheartsounds,lungs(),mildabdomenswelling,softabdomen,liver1.5cmbelowribs,bowelsounds1012/min,nohighnotes，twolowerlimbspatellarreflex(negative)InfantileDiarrheaLiquidTherapyCase analysisInfantile Diarrhe18
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